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Pediatric bipolar spectrum disorder and ADHD: comparison and comorbidity in the LAMS clinical sample
Article first published online: 21 OCT 2011
© 2011 John Wiley and Sons A/S
Volume 13, Issue 5-6, pages 509–521, August-September 2011
How to Cite
Arnold, L. E., Demeter, C., Mount, K., Frazier, T. W., Youngstrom, E. A., Fristad, M., Birmaher, B., Findling, R. L., Horwitz, S. M., Kowatch, R. and Axelson, D. A. (2011), Pediatric bipolar spectrum disorder and ADHD: comparison and comorbidity in the LAMS clinical sample. Bipolar Disorders, 13: 509–521. doi: 10.1111/j.1399-5618.2011.00948.x
- Issue published online: 21 OCT 2011
- Article first published online: 21 OCT 2011
- Received 8 February 2011, revised and accepted for publication 28 July 2011
Arnold LE, Demeter C, Mount K, Frazier TW, Youngstrom EA, Fristad M, Birmaher B, Findling RL, Horwitz SM, Kowatch R, Axelson DA. Pediatric bipolar spectrum disorder and ADHD: comparison and comorbidity in the LAMS clinical sample. Bipolar Disord 2011: 13: 509–521. © 2011 The Authors. Journal compilation © 2011 John Wiley & Sons A/S.
Objective: To compare attention-deficit hyperactivity disorder (ADHD), bipolar spectrum disorders (BPSDs), and comorbidity in the Longitudinal Assessment of Manic Symptoms (LAMS) study.
Methods: Children ages 6–12 were recruited at first visit to clinics associated with four universities. A BPSD diagnosis required that the patient exhibit episodes. Four hypotheses were tested: (i) children with BPSD + ADHD would have a younger age of mood symptom onset than those with BPSD but no ADHD; (ii) children with BPSD + ADHD would have more severe ADHD and BPSD symptoms than those with only one disorder; (iii) global functioning would be more impaired in children with ADHD + BPSD than in children with either diagnosis alone; and (iv) the ADHD + BPSD group would have more additional diagnoses.
Results: Of 707 children, 421 had ADHD alone, 45 had BPSD alone, 117 had both ADHD and BPSD, and 124 had neither. Comorbidity (16.5%) was slightly less than expected by chance (17.5%). Age of mood symptom onset was not different between the BPSD + ADHD group and the BPSD-alone group. Symptom severity increased and global functioning decreased with comorbidity. Comorbidity with other disorders was highest for the ADHD + BPSD group, but higher for the ADHD-alone than the BPSD-alone group. Children with BPSD were four times as likely to be hospitalized (22%) as children with ADHD alone.
Conclusions: The high rate of BPSD in ADHD reported by some authors may be better explained as a high rate of both disorders in child outpatient settings rather than ADHD being a risk factor for BPSD. Co-occurrence of the two disorders is associated with poorer global functioning, greater symptom severity, and more additional comorbidity than for either single disorder.